CMS Pub. 100-04, ch. 30, § 260.3.4

The NOMNC should be delivered to the beneficiary at least two calendar days before

Medicare covered services end or the second to last day of service if care is not being

provided daily. For example, if the last day of covered SNF care is a Friday, the

NOMNC should be delivered no later than the preceding Wednesday.

Note: The two day advance requirement is NOT a 48 hour requirement. For example, if a

patient’s last covered home health service is at 10AM on Wednesday and the notice is

delivered at 4PM on the prior Monday, it is considered timely.

If home health services are being provided less frequently than daily, the notice must be

delivered no later than the next to last visit before Medicare covered services end. For

example, if home health care is provided on Tuesdays and Thursdays, and Tuesday is the

last day of Medicare covered services, the notice must be delivered no later than the

preceding Thursday.

The NOMNC may be delivered earlier than two days preceding the end of covered

services. However, delivery of the notice should be closely tied to the impending end of

coverage so a beneficiary will more likely understand and retain the information

regarding the right to an expedited determination.

The notice may not be routinely given at the time services begin. An exception is when

the services are expected to last fewer than two days. In these instances, the notice may

be given by the provider when services begin.

There is an accepted circumstance when the NOMNC may be delivered sooner than two

days or the next to last visit before coverage ends. This exception is limited to cases

where a beneficiary receiving home health services is found to no longer be homebound,

and thus ineligible for covered home health care. In this circumstance, the NOMNC

should be immediately delivered to the beneficiary upon discovery of the loss of

homebound status. We expect that in the vast majority of cases, in all settings, the

decision of a physician to end care will be based on medical necessity, and thus,

foreseeable by the provider within the required time frames for notice delivery.